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As long as you're awake, let's keep talking about sleep here. Millions of Americans suffer from a condition known as sleep apnea. Most don't even know they gasp for breath, sometimes hundreds of times per night. The traditional treatment involves an extensive air pressure system. NPR's Patti Neighmond describes a potential alternative.

PATTI NEIGHMOND: Larry Barsh is a retired dentist in New York City who now dedicates himself to helping patients and dentists understand sleep apnea. But first, he wants you to hear what it sounds like.

Dr. LARRY BARSH (Retired Dentist, SnoringIsntSexy.com): The sound is usually something like this at night.

(Soundbite of snoring)

(Soundbite of gasping)

Dr. BARSH: And then that cycle repeats and repeats and repeats.

NEIGHMOND: People with sleep apnea stop breathing and then gasp so they can open their clogged airway, which is clogged either because there are too many teeth in the back of their mouth; or their tongue or uvula - that little cone-shaped bit of tissue in the back of the throat - is enlarged; or their muscles are too relaxed. People often sit up in bed alerted, but not actually awake, as they catch their breath.

Dr. BARSH: This can happen hundreds and hundreds of times a night.

NEIGHMOND: And that deprives the brain of oxygen, and puts the snorer with apnea at risk for serious health problems like high blood pressure, heart disease, diabetes and depression. And because they're tired, people often have trouble concentrating the next day. And that's particularly worrisome for those who operate heavy equipment, drive trains, planes, buses or cars. Rani Stoddard is a nurse who used to fall asleep during her 45-minute drive to work.

Ms. RANI STODDARD (Nurse): And my husband says, you know, on a scale of one to 10, I was like a 10-plus in my snoring, and now I'm like a two. You know, you get this little mild, delicate at the beginning, and then it's quiet.

NEIGHMOND: Stoddard was diagnosed with sleep apnea three years ago. The gold standard for treating apnea is a machine that uses a mask and tubes to blow air directly into the patient's airway. It's highly effective, but it's loud, cumbersome, and many patients say they just can't tolerate it. For those with severe apnea, though, it's the only choice short of surgery. But if like Rani Stoddard, people have only mild or moderate apnea, then they can use an oral appliance that fits much into mouth like a mouth guard for sports or an orthodontic retainer.

Ms. STODDARD: I want to put in my appliance. It's now in. I can talk. I can take a drink of water. Going to whip it out because it's not the most - but it doesn't hurt. It's not uncomfortable. All it does is, it just pulls your jaw forward and increases the amount of space so that your tongue doesn't get in the way and get swollen, and you sleep like a baby.

NEIGHMOND: The appliance works like a splint to keep the airway open. Stoddard says today, she's thrilled. She sleeps well, has energy during the day, and no longer falls asleep at the wheel. Stoddard's dentist, Mark Friedma, practices in Encino, California, and he says it was just six years ago that he started focusing on patients with sleep apnea.

Dr. MARK FRIEDMAN (Dentist): The vast majority of patients that we've been treating in the last six years have been patients who are already patients in our practice. It's just that we never looked for this problem.

NEIGHMOND: Over the past few years, more dentists have taken an interest in sleep medicine. Although some patients can get relief from devices they buy in a drug store. Friedman says dentists who are trained in sleep medicine are more expert at custom-fitting these appliances because they're more effective if they are precisely fitted to the individual's mouth.

Dr. FRIEDMAN: So the lower jaw is jutting forward to a certain amount. It's not an arbitrary amount. It has to be what we call a titrated position, so it needs to be just the right amount for that person. And you can't move someone too quickly.

NEIGHMOND: And often, Friedman says, it takes a couple of tries to get the right fit.

Patti Neighmond, NPR News.

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